mcnacht

I think it depends on what kind of stress, and how it affects you personally. As an RN, the stress was about getting all my tasks done in a timely manner while responding to the needs of patients, families, doctors, coworkers, and of course charge nurses/management. Sometimes the stress was because there was nothing I could really change about my situation or work life. As an NP, the stress is about my responsibility to my patient (and yes, fear of litigation if I make a mistake). But if I take some time, double check my decisions, and study up on things I'm unsure of, I ultimately have the control to change the situation that caused the stress.

I think RN and ARNP work is completely different, at least in the jobs I've had. After I got my first ARNP job, I continued to work per diem as an ER RN, but there was no conflict in my mind because they were completely different jobs. I had an English teacher in high school who sold children's shoes on the weekend, and I think it was a similar idea. You still have to be present and use some of your brain, but it's nothing like being the final responsible party with all decisions on your shoulders. I couldn't even possibly have had conflicts of overstepping my professional roles because in that hospital I had no computer access to put in a diagnosis or write a prescription as an RN, and I almost never told patients of my "other" existence as an ARNP. There also were no ARNP's in the ER where I worked, only PA-C's and MD's. I suppose it could get awkward if you were an RN working with other ARNP's when you've been similarly educated.

I say I first became a naturopathic doctor, and then became a nurse practitioner to pay the bills.

First off, congratulations on getting started on your nursing career! You'll find a lot of different personality types and a lot of different directions your career can take. It sounds like you have a very specific patient population in mind. I wonder if you might be more suited to a social work career. Though I could imagine some NP's in job areas working with that population, it wouldn't be the first group that would come to mind. Maybe talk with your sister about options in that field. Next, if you really do want to become an NP, you should probably plan on a DNP being the required entry level for the profession by the time you get there. In the meantime, you will probably have worked as an RN for a number of years and perhaps have honed your interests to a particular NP area of study and/or met some practicing NP's in those areas. Good luck!

I can't speak to CNM, since I did an FNP MEPN program. I had my first child 3 months after graduation, at age 35. It just wasn't practical to wait a lot longer to get a year of work under my belt. I wouldn't really advise to follow in my career path either: started work as an ER RN 2 months after he was born, then didn't start my first NP job for another 1 1/2 years after that. My plan had been to work in a 0.6FTE RN position, since I wasn't seeing a lot of part time NP jobs for new grads. Then my husband got laid off so I had to pick up a full time RN shift anyway. In retrospect I should have skipped the whole RN thing and just found a suitable NP position. But hindsight is 20/20, right?

First, congratulations on the prospect of soon being done with school! I can't directly comment on moving, because I'm in the opposite situation: owned a house that we were underwater on when I started looking for jobs, so no possibility of just up and moving for the best fit. I accepted what was offered that had the tangibles I needed: flexible schedule, insurance coverage for my family, and a salary I could live with. I continued at first to work extra RN shifts at my old job, and now have a 2nd NP job for training and money purposes. The advice I was given recently by a PA was to do whatever it takes to get a job in the area you want to work in, because you might get "stuck" if your first job is in an area you don't like. I don't know that that's true for NP's so much (but might be for PA's). I'm in occ med for my main job, and urgent care for my 2nd job. I wanted family practice, but have found that most places want applicants with 2-5 years of experience. The only ones I found that would take new grads didn't offer insurance coverage for family members, so I couldn't really consider them. As far as salary, the numbers you named may or may not be realistic. There is a lot of variation around the country, and you also have to consider not just base salary, but benefits package including retirement contributions, vacation time, and medical/dental insurance. Around here (Seattle), a new grad would usually be looking at 70-75K starting out unless they have some significant specialized experience or training. I'm not sure where one would get 80-90 with no experience and a tolerable cost of living. Good luck!

Not sure if this is more of a reply to n.a.norcal or to ChristineN, but I at many times HATED the masters-entry nursing program I was in. Compared with almost all of my previous educational experiences at several universities in the U.S. and Europe, as well as another graduate degree, I felt we were treated like small children who couldn't think for ourselves and had to be punished into submission. I don't think it was just my school either (though that might have been part of it), but I definitely learned the meaning of the phrase "Nurses eat their young." Interestingly, now as a practicing NP, and having gained 5 years of RN experience interwoven with school and early NP jobs, I'm starting to grow into my role and leave the school experiences behind. At times, I also thought about quitting my program, but I tried to keep in mind my original reasons for starting the program, and they had nothing to do with working as an RN or pleasing my instructors. Sorry to be a negative Nelly about school, but sometimes you just have to push through and keep the end goal in sight. If, on the other hand, you're fairly sure this profession isn't for you, by all means quit before you rack up too much more loan debt! However, when in doubt I would hang in there and get done sooner. It might be the case that clinicals is what inspires you to continue.

It may be required for new graduates. All of us with MSN's will be grandfathered in. There are now still a few non-MSN nurse practitioners around who were grandfathered in from before a masters degree was required.

"I need STD testing because my girlfriend is a pole dancer and they get exposed to all kinds of stuff, you know." "I do adult alternative activities, and I was supposed to be the holder, but someone slipped and I fell hard onto my tailbone and now I am incontinent." (medical emergency, with the TMI part for amusement) "My child has not had any vaccinations because my older child is autistic." "I was bitten by a rat when I was trying to take it out of my cat's mouth, because the rat is supposed to be food for my snake." Good times, ER triage.

And the psych/substance use patients often can NOT refuse if they are involuntarily there and the urine is the only/best way to determine presence of drugs in their system. The counselors can't even talk to them until presence of drugs is known.

I don't really see the benefit either. Depending on how many years you have left in your career, you might want to think about working slowly toward a DNP while working. I do know some people who've done that. I can't imagine a DNP will be really "required" for the next 20 years or so.

There is a recent increase in the number of free-standing Urgent Care clinics in my area. I think in some parts of the country they've been around for a longer time. I've actually been working at one of them for almost a year as an NP, and I'm having a few qualms about it. My background was as an ER nurse in a public hospital, so we saw a wide range of income levels and treated everyone regardless of ability to pay. At the UC clinic, they have to either pay cash ($99 where I work), or provide proof of insurance before being seen. In some ways I like this model, that if you're paying out of pocket, all costs are disclosed before you agree to the service. So if I order an x-ray or a lab test, or put on a splint, the patient is made aware of how much they will be charged before we do the service. On the other hand, I wonder if they get overly focused on the pricetag, and decline service based on cost. For example, I once had a patient in whom I suspected PID. She needed GC/CT testing, and an injection of Rocephin. Each of those costs over $100, and she said she could only afford one, and opted for the treatment rather than the testing. Does anyone else have moral or professional qualms about this model of care?

We went a little alternative last year after ever-decreasing participation at our annual health fair. We hired a "life coach" who brought a biophotonic sensor, or something like that. Apparently it measures the antioxidant levels in people's skin. Even if it's complete snake oil, it was an opportunity to discuss antioxidants, and people really liked to have a solid number to measure their overall health. We also do the usual cholesterol/BMI/blood pressure metrics that are pretty common.

FNP for sure if you don't know at least which age group you want to see. You can always add a certification later, but initially, FNP gives you the most flexibility. Some areas will only consider FNP's, like urgent care or the military, in case those might be in your future.

Though it's tempting for nurses to want to multitask and do EVERYTHING, I really think you should focus on one thing at a time and get really good at that thing (FNP, in your case). Though the L&D stuff may be required for CNM programs, unless you've had a huge change of heart and are PASSIONATE about that, you should work for a few years as FNP and get solid experience with a variety of people before you specialize so much. Once you become a CNM, it's likely that's all you'll do--no time to get the broad experience later. But if you get the broad experience now in a general FNP practice or urgent care, that will make you a better midwife later. Does that make sense? Good luck!